ORS 741.105
Charges and fees to be paid by insurers and state programs
- rules
(1)
The Oregon Health Authority shall establish, by rule, an administrative charge. The authority shall impose and collect the charge from all insurers participating in the health insurance exchange or offering a health plan certified by the authority and state programs participating in the health insurance exchange. The Health Insurance Exchange Advisory Committee shall advise the authority in establishing the administrative charge. The charge must be in an amount sufficient to cover the costs of grants to navigators, in-person assisters and application counselors certified under ORS 741.002 (Duties, powers and functions of Oregon Health Authority) and to pay the administrative and operational expenses of the authority in carrying out ORS 741.001 (Health insurance exchange) to 741.540 (Complaints and investigations confidential). The charge shall be paid in a manner and at intervals prescribed by the authority.(2)
Intentionally left blank —Ed.(a)
Each insurer’s charge shall be based on the number of individuals, excluding individuals enrolled in state programs, who are enrolled in health plans:(A)
Offered by the insurer through the exchange; and(B)
Certified by the authority.(b)
The charge to each state program shall be based on the number of individuals enrolled in state programs offered through the exchange.(3)
The charge imposed under this section may not exceed:(a)
Five percent of the premium or other monthly charge for each enrollee if the number of enrollees receiving coverage through the exchange is at or below 175,000;(b)
Four percent of the premium or other monthly charge for each enrollee if the number of enrollees receiving coverage through the exchange is above 175,000 and at or below 300,000; and(c)
Three percent of the premium or other monthly charge for each enrollee if the number of enrollees receiving coverage through the exchange is above 300,000.(4)
Intentionally left blank —Ed.(a)
If charges collected under subsection (1) of this section exceed the amounts needed for the administrative and operational expenses of the authority in administering the health insurance exchange, the excess moneys collected may be held and used by the authority to offset future net losses.(b)
The maximum amount of excess moneys that may be held under this subsection is the total costs and expenses described in subsection (1) of this section anticipated by the authority for a six-month period. Any moneys received that exceed the maximum shall be applied by the authority to reduce the charges imposed by this section.(5)
Charges shall be based on annual statements and other reports submitted by insurers and state programs as prescribed by the authority.(6)
In addition to charges imposed under subsection (1) of this section, to the extent permitted by federal law the authority may impose a fee on insurers and state programs participating in the exchange to cover the cost of commissions of insurance producers that are certified by the authority or by the United States Department of Health and Human Services to facilitate the participation of individuals and employers in the exchange.(7)
Intentionally left blank —Ed.(a)
The authority shall establish and amend the charges and fees under this section in accordance with ORS 183.310 (Definitions for chapter) to 183.410 (Agency determination of applicability of rule or statute to petitioner).(b)
If the authority intends to increase an administrative charge or fee, the notice of intended action required by ORS 183.335 (Notice) shall be sent, if the Legislative Assembly is not in session, to the interim committees of the Legislative Assembly related to health, to the Joint Interim Committee on Ways and Means and to each member of the Legislative Assembly. The Director of the Oregon Health Authority shall appear at the next meetings of the interim committees of the Legislative Assembly related to health and the next meetings of the Joint Interim Committee on Ways and Means that occur after the notice of intended action is sent and fully explain the basis and rationale for the proposed increase in the administrative charges or fees.(c)
If the Legislative Assembly is in session, the authority shall give the notice of intended action to the committees of the Legislative Assembly related to health and to the Joint Committee on Ways and Means and shall appear before the committees to fully explain the basis and rationale for the proposed increase in administrative charges or fees.(8)
All charges and fees collected under this section shall be deposited in the Health Insurance Exchange Fund. [2011 c.415 §17; 2012 c.38 §4; 2012 c.107 §91; 2015 c.3 §18; 2021 c.569 §23]
Source:
Section 741.105 — Charges and fees to be paid by insurers and state programs; rules, https://www.oregonlegislature.gov/bills_laws/ors/ors741.html.
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